THE CHALLENGE OF POSTOPERATIVE INFECTIONS - DOES THE SURGEON MAKE A DIFFERENCES

Postoperative infections remain a challenge in many surgical procedure s despite improved surgical technique and powerful antibiotics. The nu mber of sepsis cases has tripled from 1979 to 1992 due to increased in vasive procedures in older and immune-suppressed patients. Increasingl y, in recent years, outbreaks of resistant pathogens have been publish ed, provoking the question of how postoperative infections and resista nt pathogens should be dealt with. Wound classification and risk strat ification were developed to identify patients at risk for postoperativ e infection. However, other important intrinsic factors of the patient were not included, and further attempts have been made to increase se nsitivity and specificity (eg, Study on the Efficacy of Nosocomial Inf ection Control project, National Nosocomial Infection Surveillance Sys tem score); the American Society of Anesthesiologists preoperative ass essment score and the operation duration for specific procedures were introduced into the system as risk stratifiers. Advances in immunology have identified new ways in which the surgeon can moderate the immune response (eg, hemorrhage and blood transfusion-induced immune suppres sion). The increased rate of resistance in enterococci and staphylococ ci has refocused attention on infection control in surgery. However, t here are recent reports from both sides of the Atlantic indicating tha t guidelines for infection control and antibiotic policy have not beco me reflected in standard procedures in many hospitals. New antibiotics may be developed, but resistance soon may follow. Sound techniques in surgery, with careful infection control and antibiotic policies, may be the only strategy to prevent further increases in resistance of pat hogens in postoperative infections.